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Casualty Evacuation

by CPT Charles R. Schrankel and SFC Edward L. Britt NTC Fire Spt Div Observers/Controllers

Most field artillery (FA) battalions that come to the National Training Center (NTC) are unfamiliar with the equipment, personnel, and training required to conduct timely and responsive evacuation or casualty treatment. The died of wounds (DOW) rate for the last eight rotations has averaged 32 percent. Since most battalion-modified tables of organization and equipment (MTOEs) only authorize one ambulance, one 2 -ton truck, and 13 medics, it is critical that batteries have a plan on how they are going to treat and evacuate casualties. The following tactics, techniques, and procedures (TTPs) come from observations at the NTC, FM 6-20-1, FA Battalion Operations, and FM 8-10-6, Medical Evacuation in a Theater of Operations.EQUIPMENT

The basic equipment required to conduct casualty evacuation (CASEVAC) are litters, litter straps, and tiedowns to secure litters to evacuation vehicles. Each section should have one litter and two litter straps. Improvised litters are OK, but they may reduce the number of patients you can load on your evacuation vehicles. If you use improvised straps, remember that anything less than two inches in diameter is a tourniquet and is unacceptable. Identify requirements and purchase this equipment now. After deploying, it is too late to discover you don't have enough.PERSONNEL

With a shortage of medics in most units, it is imperative that battalions have a strong Combat Lifesaver Program. Each section should have its own Combat Lifesaver and a fully stocked Combat Lifesaver bag. Run the certification at least twice a year to ensure a steady flow of new combat lifesavers and recertification of the old. Make combat lifesaver bags an item of command interest. Inventory them at least quarterly and after every field problem. Turn in shortages to your medics and make sure the bags get restocked. A good Combat Lifesaver Program will dramatically reduce evacuation times and DOW rates.TRAINING

As always, a well thoughtout, well-rehearsed plan is the key to success. The following items must be identified and rehearsed beforehand:

Casualty Identification. You must have a plan on how to quickly identify, consolidate, and triage casualties. After a casualty producing event, sections must check on each other or the Fire Direction Center (FDC) can poll the gun line. We recommend that the platoon medic set up a triage site by the FDC. After initial treatment is given, and casualties are consolidated, the medics or other trained personnel can prioritize and supervise the loading of evacuation vehicles.

Identify Litter Squads. Litter squad members must be identified and trained. They must understand the basics of strapping a patient to a litter, transporting and lifting patients, and how to load an evacuation vehicle. FM 8-10-6 is an excellent manual that shows how to properly load just about every vehicle in an FA battalion, to include HEMTTs; however, the diagram in FM 8-10-6 is a little misleading. The diagram depicts fully loaded vehicles for casualty transport. The manual does not take into account that a medic or combat lifesaver may need to travel with the wounded to provide treatment during evacuation.

Evacuation Vehicles. At the battery level, all available vehicles should be considered for evacuation. Identify the vehicles, drivers, and medical personnel or combat lifesavers who will accompany each vehicle. The battery leadership must know its evacuation capabilities and must be able to quickly identify when the amount of casualties will become a mass casualty (MASCAL) event. A situation becomes MASCAL when the number of casualties exceeds the battery's capabilities to properly manage on-site triage, emergency medical treatment, effective communication, and evacuation assets without causing further injury to the wounded. FM 6-20-1, Chapter 7, identifies the battery XO as having staff responsibility for planning and executing the MASCAL plan. The XO must determine how he will augment battery assets if they exceed their evacuation capacity. A battery can become quickly overwhelmed, and the battalion must have a plan to shift assets from one battery to another or push assets forward from the combat trains.

Evacuation Routes. A minimum of two key leaders, normally the first sergeant and/or a platoon sergeant, must know the location of, and the route to, the Battalion Aid Station (BAS). They must drive the route to ensure they can get there in time to save their soldiers. If the BAS is too far away, the S3 or XO must be informed early so the BAS can be positioned further forward. The battery commander needs to brief the route to the BAS in his order and post the route in the BOC.

Ambulance Exchange Points (AXPs). The battalion S1 must be proactive in determining locations for AXPs and providing this information in the Field Artillery Support Plan (FASP). During the fight, he needs to stay in contact with the medical company in the Brigade Support Area (BSA) so he can track which AXPs are active. Most importantly, he must disseminate any changes in locations or activations immediately to the batteries. Battery BOCs or FACs must ensure this updated information is passed to key leaders who will evacuate casualties to medical treatment facilities.

Locations of Other Medical Treatment Facilities. Each maneuver task force has a Forward Aid Station (FAS) and a Main Aid Station (MAS). These assets are often closer to the firing batteries than the FA BAS. The S1 must coordinate with his maneuver counterparts in the BSA for FAS and MAS locations and include them in the FASP. As with AXPs, he must track locations during the fight and disseminate changes to the batteries.SUMMARY

During any combat operation, each unit is susceptible to casualties any time. It is imperative that all units have a Standing Operating Procedure (SOP) describing, in detail, actions which must occur to take care of the dead and wounded. These procedures must be understood by everyone and practiced at home station. The results of an effective CASEVAC plan are quick and efficient reactions to a casualty producing event, maintenance of combat power with timely treatment and evacuation of wounded, and trust and confidence of soldiers in unit leadership's abilities.



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